Circumcision device

ABSTRACT

Device performing circumcision, of the type having a hollow bell (or ring), a semi conical part and handle which prevent slipping of ring over penile shaft. The device has a circumferential flange  23  at its anterior part connected to the body posteriorly by a circumferential groove  24.  This flange is connected anteriorly to a semi conical hollow part  21.  Its anterior opening is incomplete circle  27  connected to big opening  22  at the base of the conical part, the connection in between is a narrowest slot to keep the shape and property of the cone. The handle  20  is in the form of inverted Y, 2 mm thick, connected by both legs to the top of the anterior edge of the semi conical part. This connection is weakened to be easily broken after finishing the operation. After positioning the device with suitable size over the glans, the foreskin is pulled over and tied firmly to be strangled over the circumferential groove. Then trimming the distal skin and breaking the handle, leaving the device in place till it falls down and separate within 5-7 days. Presence of the semi conical part with its opening at its base prevent slipping of the device over penile shaft and its complications and also preventing accumulation of urine and inflammation.

TECHNICAL FIELD

The male circumcision surgery is considered one of the oldest and most common surgeries. It has been known since the ancient Egyptians as stated in the teachings of Islam and Judaism, and the modern science proved its importance as it was found that the men who did not perform the circumcision surgery are more likely to have penile cancer, and their wives are more likely to have cervical cancer. One of the most common methods for this surgery is by using bone scissors or Mogen Clamp Device, and after cleaning adhesions that exist with the penis skin, the skin is held with two arterial forceps to pull the skin through the bone scissors jaws, or Mogen Device Jaws, which is semi closed to prevent the head of the penis to slide away from the device. Then the scissors (these scissors cannot cut skin) or Mogen Clamp is closed for a while, then the skin is cut by a surgical lancet, then the bone scissors or Mogen Clamp is opened. However, although this method is simple, it has many extremely dangerous disadvantages: the head of the penis, or even the urine hole, may slide between the bone scissors jaws or Mogen Clamp. It is difficult to note that even with the most experienced, and it is cut with the lancet, which may cause severe bleeding, because there is a lot of blood feed the head of the penis, at the least, when the hole of urine is cut, it may cause pain with each time of urination for a long time, until the wound is healed. When the wound is healed, fibrosis may occur with tightening in the urinary hole. It is also possible that, as a result of using this method with newborn children (which does not occur after all the blood clotting factors or those who experience Hemophilia), this may lead to severe bleeding, and the severe bleeding occurs in the children who are older than one year old, as the arteries are large, this bleeding cannot be stopped unless by taking stitches and hold the arteries which bleed by the clamp to tie them or by electric cauterization.

One of the most common methods in the Arabian area is using a Plastic device (Plastibell) from Holister Company (figure no. 1). This is made of the transparent plastic, with bell shape, this device is available in 6 sizes from 1.1 to 1.7 cm. It is sterilized to be used only once. After using the appropriate Topical anesthetic, and putting the device with the appropriate size on the head of the penis, the skin is pulled to the device and the doctor shall tie a strong medical thread on the skin above the cavity and aperture that exist in the human body. Then the external foreskin skin is cut after the tie with leaving 2 mm of the foreskin. Then the handle is broken off at the end of the procedure. Then the device is left until it separates and falls in a period from 5 to 7 days. Along this period, the infant does not need any change or particular procedure. After the device falls off and the extra skin, then a healed line remains. One of the serious disadvantages of this device, when using a larger size or tighten the skin more than required, so the ring may slide to the crus of the penis, which may cause skin ecdysis, and it cause damages to the internal tissues with serious trauma in the penis, with compaction of the ring and urine retention. And the only solution in this case is to break the ring carefully and treat the previous complications. However, if the selection of the device is little smaller, it may cause pits in the compacted parts on the sides of the head of the penis, with topical swell around the urethrae, and the retention of urine, as well as the remaining skin, may be more than required, with which the surgery is required to be repeated.

I presented an invention (Patent No. 17446) (FIG. no. 2) to avoid the defects and side effects provided hereinabove, as I kept the body of PLASTIBELL and added a semi conical shape at the top of the device shape (Fig. No. 2) No. 7); therefore, I prevented the device from sliding to the crus of penis, so the doctor became fearless from the bad choice of the larger size, and does not have to choose the smaller size and their contradiction.

PRIOR ART

One of the most serious disadvantages of PLASTIBELL Device is selecting a slightly larger size or tighten the skin more than required, so the sliding of ring to the crus of the penis is necessary (shape 17 and 18), which may cause ecdysis and damage to the tissues with sever swelling in the penis, and the impaction of the ring with the retention of urine. And the only solution for this problem is to break the ring (Fig. No. 19) carefully before the circumcision process is completed and treating the above said complications. However, if the device was smaller than appropriate, it may cause pits in the compacted part on the sides of the penis, with the occurrence of topical swelling around the urine passage and retention thereof. In addition to the amount of skin may be more than usual, with which is required to repeat the surgery.

I presented an invention (Patent No. 17446) (Fig. No. 2) to avoid the defects and side effects provided hereinabove, as I kept the body of PLASTIBELL and added a semi conical shape at the top of the device shape (Fig. No. 2) No. 7); therefore, I prevented the device from sliding to the crus of penis, so the doctor became fearless from the bad choice of the larger size, and does not have to choose the smaller size and their contradiction.

This new device is for avoiding medical technical defect and defects of manufacturing.

However, for the manufacturing defects, it is in the position and place of the handle of the device of Patent No. 17446, it is a crescent shape connected to the device and separated from the conical shape (FIG. 2 No. 5), the defects thereof are that when manufacturing the device by injection of Liquefied plastic from the highest point, it is the handle of the device, so the shape of plastic cannot reach the conical shape and fill it with the required efficiency. The amendment was by the positioning of the handle of the device is above the flange of the conical shape (figure No. 3 and 4) No. 10.

So, by injecting the plastic, the handle of the device, the conical shape and the body of the device.

However, the medical and technical defects is that the internal area between the conical shape the head of the penis is small, and the opening that exist at the bottom of the conical shape (Fig No. 2) No. 8 is not enough to discharge urine, which remains collected in this area with the theory of surface for many days, whereas the urine of infant is more basicity, it is more exposure to the reproduction of Bacteria and the occurrence of inflammations in this area. So, the second alteration is by making a large opening in the conical shape from the bottom and connected tightly to the upper opening Shape 3 and 4) No. 12, for dispense any collected urine at the same time, with keeping the conical shape which prevents the sliding of the ring to the crus of the penis. So, the device presented now consists of all the steps of the surgery, and the specifications of both Plastibell devices and the two devices of Patent No. 17446, with avoiding the defects of each of them.

Description

This device (of shape 3 and 4) consists of 3 parts:

The first one:—is the body of the device as shown in No. 15, and it is made of transparent strong plastic, or any of flexible plastic of 1 mm thick. It is like a bell; its base No. 16 is a rounded opening it outer diameter varies according to the size of the device. So, it has many sizes (according to the length of this diameter), which ranges between 1.1 cm to 1.7 cm. After the rounded opening, then the body curves while approaching to the rounded flange no. 13, so the curve increases to became aperture and rounded cavity No. 14 intersected with the rounded flange. The outer diameter of the rounded flange is the same diameter of the base no. 16, The thickness of this flange is 2 mm on the other side of the round flange, there is a semi conical shape no. 11, with a rounded base connected to the flange and the top of the semi-conical shape as an incomplete rounded opening. There is a large opening in the conical shape from the bottom, connected tightly with the opening of upper opening no. 12.

Second part:—it is the handle of the device as shown in No. 10. It is made of strong transparent plastic, or any of the flexible plastic with 2 mm thick, connected with the top of the semi-conical shape at the rounded opening. Noting that, the connecting point is easy to be broken, to be separated from the handle of the body. (Fig. No. 16)

Part No. 3: As shown in No. 17, it is a thread, of that type used in surgeries, or any of the threads that are silk processed, or that can tolerate pulling. The length of this thread is 30 cm and white.

The method of using the device:

-   -   1. Using the appropriate topical anesthetic     -   2. Hold the two edges of the skin by 2 small arterial lancets.     -   3. Insert thin sensor gently between the skin on the upper         surface and the head of the penis, then separate the two adhered         surfaces by moving the sensor left and right (figure No. 8). And         we shall not approach the lower part as of 4 pm to 8 pm.     -   4. Spread the skin by pulling the flanges gently by another         arterial lancet, or the best is (Kocher) it is a lancet         specialized for squashing the tissues. Squash a part of the         upper surface of the skin to an area not less than ½ cm from the         end of the head of the penis (the area shall be measured before         pulling the skin, in order to fix the device (Figure no. 9).         mashing shall be by closing the lancet on the skin and to be         left for half a minute, disconnect it. For this reason, not even         one drop of blood bleeds when this mashed part is cut, as all         the blood vessels are adhered and blocked.     -   5. By surgical scissors, the mashed part is cut, in a manner         that does not exceed end of the mashed part (Figure no. 10)     -   6. Raise the Forceps up gently with spacing between the skin and         the head of the penis by a gauze until all adhesions are         removed, and the borders of the head of the penis became         completely clear from all sides. (Fig. No. 11)     -   7. Tie the silk thread around the penis (to be rounded twice)         and let it be loose at the bottom of the penis (Fig. No. 12)     -   8. Put the device with the appropriate size on the head of the         penis, see (Fig. No. 5, 6 and 7) to select the appropriate size.         It shall be taken into consideration that the opening that         exists at the bottom of the conical shape and connected to the         upper rounded opening (FIGS. 3 and 4) No. 12 shall be to the         bottom, to enable better urination, without accumulation of         urine, to avoid the reproduction of bacteria and occurrence of         inflammation.

It is better to select the appropriate size (Fig. No. 5), but if the doctor failed and the size was bigger than required (Fig. No. 7) the device will no slide to the crus of the penis, as may be occurred in Holester Device (Fig. No. 17 and 18, because of the semi conical shape of ten (Fig. No. 2 and 4 (No/. 11), as this is the most important feature in this device. so, the slide of the ring to the crus of the penis, which may result in skin Ecdysis and swell of the penis, with the inability to return the ring to its right position, then the only solution to break it as soon as possible, with completing the adequate period. This is what occurs with Holester device (Fig. N. 19). The mistake in this case, either because of the lack of experience of using the device. It is well known that the penis of the child is in the case of an erection. For example, before urination, so the size of the penis is larger than its natural size, the selection is made on this basis. Fig. No. 5 and Fig. No. 7 show the simple difference between the appropriate size Fig. No. 5 and the larger size (Fig. No. 7), which may cause the unintended mistake by the doctor. However, if the size of the device is smaller than required. the pressure on the sides of the penis for 5 to 8 days before the device is separated, will cause pits on the compacted parts at the sides of the head of the penis, which may cause topical swelling around the urine passage, which may result in its retention. As well as selecting the smaller size makes the circumcision process incomplete and need to be repeated, as the remaining skin is long. So, the complications resulted from selecting the inappropriate size are similar in both devices; the explained device and Holester Device.

It shall be known, that the doctor who uses PLASTIBELL Device of Holester feels fear while selecting the appropriate size, in fear of the slide of the ring to the crus of the penis, which obliges him to choose the smaller size precautionary, so the complications which result from selection of the smaller size occurs. However, in the case of the device in question, there will be no fear of sliding, thus there is a possibility to use a smaller size, thereby, we avoided all complications and defects in PLASTIBEll and the above device of Patent No. 17446.

-   -   9. Stretch and pull the skin gently by the two Forceps with         putting the device on the head of the penis, then it is covered         with the skin, so that the end of the incise at the back of the         skin apart from the notch in the device (Fig. No. 12). The         advantages of this device are that it avoids the complications         that occur when the doctor tightens the skin more than required,         in purpose of removing the largest part of the skin, as the         conical shape is at the top of the device's body, whilst the         device of Holester slides, even with selecting the appropriate         size to the head of the penis, but tightening the skin more than         required may result in the pressure on opening of urine passage.         This may be avoided by looking to the urine passage to ensure         the non-compression thereof, before tying the silk Thread (step         No. 11)     -   10. If this surgery is performed without an assistant, you can         hold the skin with fixing the device in hand, until he is able         to tie the thread by another arterial forceps as shown in Fig.         No. 13.     -   11. Tie the silk thread tightly on the skin around the aperture         and the cavity in the device, the skin is pressed in this         aperture, which results in the lack of blood supply to the         remaining skin. Then cut the extra silk thread Fig. No. 14. The         knot shall be so tight, otherwise, it will cause bleeding and         the device will fall off, or the incompletion of the         circumcision surgery, as it may need to remove another part of         the skin. Ensure that the opening of the urine passage is not         closed or compacted because of tightening the skin more than         required, before tying the silk thread.     -   12. Cut the extra skin around the outer edge of the device (Fig.         No. 15)     -   13. Break the handle of the device with leaving the thread and         the remaining part of the device in place (Fig. No. 16)

Final result:

The outer skin of the knot has pits, then the device and the silk thread is separated and fallen off within 5 to 8 days, leaving a healed clean line. Along this period, the child does not need to change the bandage, or any special precautions, the child may be given a shower or be rinsed without any fear.

It is possible to cut the thread and remove the device after 48 hours according to the desire of the doctor and at is sole discretion without any side effects or any change in the shape of the circumcision.

BRIEF DESCRIPTION OF DRAWINGS

Figure No. 1: It is PLASTIBELL Device of Holester Company.

-   -   1. Body of Device     -   2. The flange used as a guide to cut the skin on its edge.     -   3. The breakable handle after performing its function.     -   4. The front opening of the device. You can observe its         wideness, so it is easy that the body of the device slides to         the crus of the penis.

Fig. No. 2: It is the previous device for me with Patent No. 17446

-   -   5. The handle of the device is connected to the flange No. 2 and         is separable from the Semi-Conical Shape no. 3.     -   The handle of the device is separable after performing its         function.     -   6. The flange used as a guide to cut the skin on its edge. (2 mm         thick)     -   7. The semi conical shape which is added to Plastibell device to         prevent the body of the device from sliding to the crus of the         penis.     -   8. A small opening to prevent the accumulation of urine at the         bottom of the conical shape that connected with the body of the         device.     -   9. Fig. No. 3 The new device required to be examined to obtain         the patent, However, shape no. 4: It is a 3D shape for the same         device.     -   10. The handle of the device is separable after the performance         of its function.     -   11. The semi-conical shape which is added to Plastibell in         Patent No. 17446, and it is added too after it is justified t         (to prevent the body of the devise from sliding to the crus of         the penis.     -   12. The opening added to the conical shape is large from the         bottom and connected tightly with the upper opening, with which         it prevents the accumulation of urine completely, and the         conical shape maintains its function.     -   13. The flange used as a guide to cut the skin on its edge. (2         mm thick)     -   14. The pits and the cavity exist in the body of the device, as         the skin is tied above the cavity to prevent the blood from         reaching the extra skin. Then the skin has pits until the skin         and the device is separated from the head of the penis within         one week.     -   15. The body of the device is completely similar to PLASTIBELL         device, and the previous device for me with Patent No. 17446.     -   16. The opening of the device bottom is a circle with a diameter         that identifies the sizes of the device from 11 mm to 17 mm The         appropriate size shall be selected. See figures No. 5, 6 and 7).     -   17. Strong medical thread, which is used to tie the skin above         the aperture and the cavity exist in the body of the device.     -   Figure No. 5: It represents how to select the appropriate size         to the head of the penis (in a manner that does not exceed the         pits of the head of the penis).     -   Figure No. 6: It represents when it is required to use a smaller         size than the size of the head of the penis.     -   Figure No. 7: It represents when it is required to select a         larger size than the head of the penis. (in a manner that does         not exceed the pits of the head of the penis)     -   Figure No. 8: It represents step no. (1-2-3) of how to use.         After using the appropriate topical anesthesia, the ends of the         skin shall be held by two small forceps. Then enter thin sensor         between the skin gently in the upper surface and the head of the         penis, then space between the two surfaces by moving the sensor         right and left. You shall not approach the lower part as of 4 pm         to 8.

Fig. No. 8: It represents the step No. 4 of how to use. Stretch the skin by pulling the forceps gently, by another arterial forceps or the best is (Kocher), it is forceps specialized for mashing the tissues. Mash a part from the upper surface of an area not less than ½ cm from the end of the head of the penis (the area is measured before stretching the skin), to be able to fix the device. The mashing shall be by closing the forceps on the skin, then to be left for ½ a minute the n released. So, no bleeding occurs when this mashed part is cut, as all the blood vessels are blocked and adhered.

Figure No. 10: It represents step no. 5 of how to use. Showing the mashed part, which shall be cut by surgical scissors, in order that this cut shall not exceed the end of the mashed part.

Figure No. 11: It represents step no. 6 of how to use, raise the two forceps gently and continue spacing between the skin and the head of the penis with a piece of gauze until all adhesions are removed, so the borders of the head of the penis are completely clear from all sides.

Figure No. 12: It represents step no. 7 and 8 in how to use, Tie the silk thread around the penis (to be rounded twice) and let it be loose at the bottom of the penis. Put the device with the appropriate size on the head of the penis, in order that the end of the cut part of the skin is far away from the pits on the device.

Figure No. 13: It represents step No. 10 of how to use. If the circumcision process is performed without an assistant, you can hold the skin with fixing the device in hand, until you can tie the thread by another arterial forceps.

Figure No. 14: It represents step No. 11 of how to use. Tie the silk thread tightly on the skin around the aperture and the cavity in the device; thus the skin is pressed in this aperture, which results in the lack of blood supply to the remaining skin. Then cut the extra silk thread.

Figure No. 15: It represents step No. 12 of how to use. Cut the extra skin around the outer edge of the device 2 mm away.

Figure No. 16: It represents step No. 13 Break the handle of the device with leaving the thread and the remaining part of the device in place.

Figure No. 17: Represent the slippage of sliding of Plastibell Device to the middle of the crus of Penis.

Figure No. 18: It represents the Ecdysis of skin completely at the end of the part on which Plastibell device stopped sliding, with swelling and retention of urine.

Figure No. 19: it represents the breakage of the plastibell device after it slides and stops at the middle of the crus of the penis. 

1. A circumcision device comprising a ring in the form a hollow bell shaped body, a semi conical part connected anteriorly and a handle. It is designed to prevent slipping of the ring through the penile shaft and assures easily disposal of urine without accumulation.
 2. A circumcision device as recited in claim 1 wherein a ring bell shaped body having a tapered interior surface, an anterior end, and anterior opening which is connected to the semi conical hollow object with an open posterior end. A posterior opening defined by the interior surface at the posterior end which is larger than the anterior opening, a longitudinal axis extending between and through the anterior and posterior openings. A semi conical object extending over the anterior opening and fixedly connected to the anterior end of the body at a circumferential flange thereof on exterior surface, and a groove circumferentially defined around the exterior surface adjacent to the anterior end between the circumferential flange and the rest of the body.
 3. A circumcision device as recited in claims 1 wherein the semi conical part has a large opening at its base with its connection to the circumferential flange and an anterior opening connected to the opening by a narrower slot keeping the shape and the property of the semi conical part preventing the glans from any slight protrusion and in the same time prevent accumulation of urine in this small area.
 4. A circumcision device as recited in claims 1 wherein a handle is in the form of inverted Y shape, 2 mm thick, connected by both legs to the top of the anterior edge of the semi conical part. The handle extending longitudinally and outwardly from the junction and being structurally weaker at and adjacent to the junction than any other portion of the handle to thereby make the handle readily breakable and detachable from the edge of the semi conical part at the junction. The presence of the handle attached anteriorly to the top of the semi conical object (not to the top of the body in some devices or to a bridge in others or away from the semi conical part as in my invention) help during manufacturing the device by injecting plastic mold at the top of the handle to equally and satisfactory distribute liquid plastic through the semi conical part and rest of the body. This handle is used during positioning and fixing the device on the glans and ligating the skin. 